30 January 2011

A U.S. Marine carries a wounded colleague to a medevac helicopter with the U.S. Army Task Force Shadow "Dust Off", Charlie Company 1-214 Aviation Regiment after their convoy, including the destroyed truck at background left, hit an improvised explosive device near Marjah in Afghanistan's southern Helmand Province on Thursday, Jan. 27, 2011. (AP Photo/Kevin Frayer)

You may have noticed in the photo above that the Marine being carried has one bare foot and that the removed boot has been tied to his pant leg.

The combat boot of a wounded U.S. Marine sits next to him on a medevac helicopter from the United States Army's Task Force Shadow 'Dust Off', Charlie Company 1-214 Aviation Regiment after he was injured by an improvised explosive device near Marjah, in southern Helmand Province, Afghanistan, Thursday, Jan. 27, 2011.(AP Photo/Kevin Frayer)

Well, looks like that boot made it with him on the MEDEVAC bird. I'm sure he was pleased with that. The guys hate losing pieces of gear, and often complain about how all of their clothing (including boots) may be cut off during examinations after MEDEVAC. It's a safety precaution, of course. Additional wounds, such as those from shrapnel, can be unnoticed by a patient who is focused on the pain of a larger, more obvious one.

25 January 2011

Scenes from pre-deployment training, to Afghanistan, Landstuhl, and stateside medical facilities are featured in this video, which according to its description at YouTube, was made "to honor the wounded & fallen heros of 3/5, i could only capture my personal journey & are obviously many more injured that i could not include but we thank all the families & darkhorses for their sacrifice & commitment. 3/5 GET SOME!!"

U.S. military hospitals in Landstuhl, Germany; Bethesda; and San Diego have seen a steady stream of wounded Marines and sailors from the Three-Five, including at least four triple-amputees.

In four months, 24 Marines with the Camp Pendleton-based Three-Five have been killed.

More than 140 others have been wounded, some of them catastrophically, losing limbs and the futures they had imagined for themselves.

The Marines' families have been left devastated - or dreading the knock on the door.

"We are a broken-hearted but proud family," Marine Lt. Gen. John Kelly said. He spoke not only of the Three-Five: His son 1st Lt. Robert Kelly was killed leading a patrol in Sangin.

The Three-Five had drawn a daunting task: Push into areas where the British had not gone, areas where Taliban dominance was uncontested, areas where the opium poppy crop whose profits help fuel the insurgency is grown, areas where bomb makers lash together explosives to kill and terrorize in Sangin and neighboring Kandahar province.

The result? The battalion with the motto "Get Some" has been in more than 408 firefights and found 434 buried roadside bombs. An additional 122 bombs exploded before they could be discovered, in many instances killing or injuring Afghan civilians who travel the same roads as the Marines....

By some accounts, no district in Afghanistan is outpacing Sangin in "kinetic activity," military jargon for combat.

"Sangin is a straight-up slug match. No winning of hearts and minds. No enlightened counterinsurgency projects to win affections," said Bing West, a Marine veteran who was an assistant secretary of Defense under President Reagan. "Instead, the goal is to kill the Taliban every day on every patrol. Force them to flee the Sangin Valley or die."...

Marine brass, to whom heroes of the past stand as the measure of all things, say the Three-Five is writing its own chapter of combat history. Marine Commandant Gen. James F. Amos, who spent Christmas in Sangin, said the Marines there are writing "a story of heroism, of courage, of fidelity."

A victory over the Taliban in Sangin, American officials hope, would bolster the confidence of Afghan President Hamid Karzai's government and possibly push the Taliban into a negotiated settlement, allowing the United States to withdraw its troops by the 2014 target set by the Obama administration.

Maj. Gen. Richard Mills, the top Marine in Afghanistan, has called Sangin the last major Taliban stronghold in Helmand, although there are other pockets of insurgent activity in the province.

Fighters from Pakistan use Sangin as a staging area before launching into other parts of Afghanistan, particularly into neighboring Kandahar province.

"We know that the senior leadership (of the Taliban) outside the country is very concerned that this area is going to slip away," said Col. Paul Kennedy, commander of Regimental Combat Team Two, which includes the Three-Five.

24 January 2011

Continuing his Vantage Point series at the NYT's At War blog, CJ Chivers revisits the events of May 27, 2010. The Marines were on a foot patrol when an IED killed Cpl. Jacob C. Leicht and wounded Cpl Brett R. Sayre. Mr. Chivers was embedded with the MEDEVAC crew who responded that day. In this piece, he focuses on the improvement in protective equipment that saved Cpl. Sayer's life - and the ballistic eye wear that saved his eyesight.

To examine for yourself the immediate effects of Corporal Sayre’s wounds, watch the video ... from the moments after the helicopter landed. You’ll see he was disoriented, bloodied and effectively blind. (Warning: Graphic content.) You’ll also see that he is intact. His armor and helmet appear to have prevented what could have been more gruesome and grave trauma.

But what of his eyes?

Inside the Black Hawk, he was asked by the flight medic whether he could see. The corporal had a single-syllable answer: “No.”...

Watch the video closely as Corporal Sayre is escorted to the aircraft, and as the flight medic tries to comfort him and begin the exam. Look him over.

Corporal Sayre’s helmet shielded the upper portion of his cranium. His short hair was swept flat and burned, but he did not suffer a penetrating wound to the skull, as many victims of bomb blasts do. The vest shielded his torso from shrapnel. He could well have suffered internal bleeding; it was too soon when this video was made to tell.

But unlike the victims of bombs who were not wearing flak jackets and are commonly seen at blast sites, his torso is not a mess of holes. The ballistic groin flap kept debris from striking his genitals. The fire-retardant uniform he wore prevented extensive burns on his limbs, which protruded from the Kevlar of his vest and suffered light shrapnel wounds (He did have burns on his left arm, reaching to his armpit, from where bomb’s heat flashed up his sleeve. Memo to those who walk these kinds of walks: Button and cinch down your uniform and keep everything tight).

In sum, much of this young corporal’s body was protected from any number of wounds that might have killed him, or, at a minimum, made his case – and his future — much more complicated.

Now let’s have Corporal Sayre describe the wound to his face:

I was 15 feet from the actual blast. I had total face wounds. I lost all the skin from my nose to my neck. Burned right off. And my goggles were destroyed. I couldn’t even open my eyes. I was blind. I couldn’t see a thing.

22 January 2011

Joe Gonzales, a wounded Marine who is now a Soldiers' Angels employee, and Soldiers' Angels Executive Director Toby Nunn. The pair have been invited to attend a special NFC Conference Championship football viewing party at Fort Meyers with the Vice Chairman of the Joint Chiefs, General Cartwright. Courtesy photo.

From Soldiers' Angels co-founder Jeff Bader:

Soldiers' Angels has been invited to attend an NFC Conference Championship football viewing party at Fort Meyers with the Vice Chairman of the Joint Chiefs, General Cartwright. This is the second time Soldiers' Angels has been invited to this special event. Last year Soldiers' Angels Co-founder Jeff Bader and (now) Executive Director Toby Nunn attended.

The event is an opportunity for Wounded Warriors and those who support them to be able to share in a moment of fellowship while watching a championship football game.

This year, Joe Gonzales - a wounded Marine who is now a Soldiers' Angels employee - will be attending along with Toby Nunn. This will allow Joe to reconnect and take another step in his life forward as he is able to stand alongside his comrades and provide more than emotional support. Guests will also share the experience with former NFL players and other select celebrities in attendance, making the intimate gathering a wonderful experience for all involved.

Soldiers' Angels is honored to have this wonderful oppurtunity to not only meet with senior military leadership and wounded warriors, but to engage in the great American tradition of watching a championship football game.

Go, Joe! And go [insert name of your favorite team for the game here]!

John Masson makes his way through well wishers Friday as he heads into the Porter County Airport terminal after arriving home for the first time since being seriously injured in Afghanistan in October. Photo: Jeffrey D. Nicholls/Post-Tribune.

At 5:46 p.m., the crowd watched a small plane land on the dark runway. Masson's three kids, Jonathan, Morgan and Ethan, peeked through the tiny windows at a crowd that yelled, whistled and applauded before mobilizing into action.

"That's him!" one boy yelled. "That's the hero."

The donated plane used to fly Masson and his family came via Veterans Airlift Command, a wonderful program that provides free air transportation to wounded veterans and their families....

Flanked by his wife and kids, Masson's wheelchair rolled through the impromptu field of honor, with American flags waving above. Veterans saluted. Men cheered. Women cried. It was one of those rare goose bump moments in life.

"Welcome home, John!" a friend yelled.

Masson smiled the whole way inside, recognizing a few faces while not having a clue about dozens of other strangers who showed up, just because. With both legs missing, he leaned up to give hugs to several people, wrapping his prosthetic left arm around their neck as best he could.

"This is why we do what we do," he said, referring to military personnel who write a blank check to Uncle Sam when they enlist. "I'd do it all again."

Someone mentioned Masson's well-known determination to walk again and the crowd erupted.

Dustina was asked her reaction to the hero homecoming, but emotions choked her reply.

Covering for his wife of 18 years, Masson told the crowd, "Thank you all so much for coming out."

From John's web site, where you can find out more about his recovery with lots of great photos, leave a message in his guest book, or make a donation:

SGT 1st Class John Masson was recently wounded in Afghanistan. John has proudly served our Armed Forces for 11 years. The first of those four years were served in the Army and the last seven with the National Guard. He is a Ranger tabbed Special Forces Medic who is also a Veteran of Desert Storm, Operation Iraqi Freedom and Operation Enduring Freedom.

On Saturday, October 16th, 2010, John's life changed forever.

John Masson, our hero, our friend, sacrificed 3 extremities in Afghanistan, for their freedom, as well for The United States of America - Land of the Free - Home of the Brave. His courage and dedication for our country allows all to sleep in peace at night which goes way beyond our call of duty. Along with our appreciation of all of the Armed Forces, sometimes our freedom comes at the price of death as we are so thankful that John is still here alive today. Despite the severity of his of his injuries - John said, "I will walk again". If anyone knows him personally - HE WILL!!!

Update, just found the story at the website of his local TV station, CBS Chicago.

A virtual Afghan street featured in the T2 Virtual PTSD Experience, based in the internationally populated virtual world called Second Life. This immersive, interactive learning activity is a public site designed for warfighters and their families. It educates visitors about combat-related post-traumatic stress and offers resources for seeking help. Photo courtesy of the National Center for Telehealth and Technology.

The Department of Defense (DoD) announced today the launch of an interactive simulation designed to help those dealing with post-traumatic stress disorder (PTSD).

The National Center for Telehealth and Technology (T2) developed the ‘Virtual PTSD Experience’ to help combat veterans and their families and friends to anonymously enter a virtual world and learn about PTSD causes, symptoms and resources.

“We believe this is the first time DoD has used interactive simulations with the Web to help our military community with PTSD in the privacy of their homes," said Dr. George Peach Taylor Jr., principal deputy assistant secretary of defense for health affairs.

The Virtual PTSD Experience was designed to be used in the privacy of homes. Visitors are anonymous, which reduces the perceived stigma of asking for help with PTSD.

“We created an environment that lets people learn by doing, rather than reading text and watching videos on two-dimensional websites,” said. Kevin Holloway, the psychologist who led T2’s virtual world development. “They can learn something new each time they visit.”

Their grunt's-eye-view seems to agree with that of senior leadership. Maj. Gen. Melvin Spiese, the new deputy commander of the 1st Marine Expeditionary Force headquartered at Camp Pendleton, had this to say on Wednesday:

U.S. Marines are expanding their relationships with tribal leaders in Afghanistan to build a bulwark against the Taliban as violence subsides in several areas of Helmand province, the new deputy commander in charge of the 1st Marine Expeditionary Force headquartered at Camp Pendleton said Wednesday.

Such relationships are proving to be the fulcrum that will determine success or failure in Afghanistan, as they were when the Marine Corps was stationed in the Anbar province of Iraq during the height of the insurgency, Maj. Gen. Melvin Spiese said in a speech before a gathering of the San Diego Military Advisory Council....

Spiese said Taliban attacks have fallen off in once restive areas like Marjah and Nawa, and U.S. casualties waned in recent months in the most violent northern reaches of the province, in Musa Qala and Sangin.

Building relationships with the tribal leaders has been a key aspect of the turnaround in southwestern Afghanistan, where roughly 20,000 Marines are stationed — about half of them from the force based at Camp Pendleton.

“That’s really where the success or the failure of our operations is going to be. It’s in the villages, it’s in the tribes,” Spiese said. “In order to be successful there, to root out the Taliban, to make sure that we are able to implement some of the changes necessary … it really is working village by village and talking to the elders who control the decisions in those areas.”

Afghanistan’s diffuse tribal structure presents more challenges compared to what the Marines faced in Iraq, Spiese noted. “In Iraq the tribal structure was very hierarchical. Senior tribal leaders could make decisions that could reach across the province.”

In Iraq, the local Sunni tribes were caught in the middle between U.S. forces and foreign al-Qaeda fighters. In Afghanistan, “the Taliban are not necessarily local when they pass through, although they can be very intimidating. So getting the locals to feel comfortable enough to facilitate the exchange of information that allows us to root out the Taliban requires a lot of work.

“But it is going to happen at the local level, because that is where the IEDs (improvised explosive devices) are planted, that is where the ambushes are planned.”

U.S. Marines had moved into the Marjah area of Helmand province in Afghanistan in February 2010 and were bogged down in heavy combat for months. “If you go to Marjah today you will find the markets are open, schools are open and we see Marjah as relatively benign,” Spiese said, adding that similar changes occurred in Nawa as well.

Insurgents who once operated in those areas have moved north to Sangin, Spiese said. The Marine commander in charge there, Maj. Gen. Richard Mills, has described Sangin as the last stronghold of the Taliban in Helmand province.

Tribal leaders in Sangin struck a peace deal with international forces earlier this month. Since then Camp Pendleton’s 3rd Battalion, 5th Marine Regiment stationed in the area have not announced any combat deaths.

Earlier this week, Al Jazeera's Riz Khan discussed that recent peace deal in the Sangin district with Marine Major General Richard Mills, the commander of coalition forces in Helmand province.

Sgt. 1st Class Joshua Friedbauer receives acupuncture just prior to his flight to the States. Friedbauer, of the Army National Guard's 20th Special Forces Group, is one of the first participants in a study examining whether acupuncture can effectively be used in air evacuation flights. Seth Robbins/Stars and Stripes.

For the first time, doctors are testing acupuncture to treat injured troops in transit from Ramstein to the States.

The servicemembers are part of a study, looking at whether battlefield acupuncture — a procedure that involves placing tiny needles into troops’ ears — can be effectively used to control pain during an air evacuation.

19 January 2011

The first clip will be one of several showing the Afghan countryside from the back of Black Hawk helicopters crisscrossing the region on medevac runs. Today’s post covers the pickup last year of a Marine who had been shot in Marja. This particular clip was selected to provide a fuller view of what NATO and Afghan troops patrolling in Afghanistan often face, and the speed with which events happen and decisions are made.

It opens with a high-speed, low-elevation view of the so-called green zone in Helmand Province — the irrigated areas of the steppe where most of the people in the province, and the fighting, are found. This is Afghanistan’s poppy belt, and thus it is the agricultural source of much of the country’s opium, although this footage was shot a few weeks after the 2010 poppy harvest. That’s the reason many fields have been freshly tilled. The plantings for summer crops had begun....

Look at the video, which will show a small Marine unit under fire as it tries to treat and evacuate a wounded corporal. Look at the ground around them, and the way that potential combatants can be hard to distinguish from civilians.

From the air, some of the character of counterinsurgency warfare in general, and of the Afghan war in particular, can be visible in stark ways, as it is here.

"I was thinking here we go another day whatever, not a big deal and I was reaching up to turn something on my rifle and just like that I had gotten up hit. And I sat up screaming," Stroble said about the incident. "Initially, I thought I was going to die because I knew I'd gotten messed up, I'd gotten shot in the face, there was blood pouring out of my face and blood coming out of my shoulder."

Fellow Marines quickly took action to bring him down from a lookout point and onto a waiting helicopter. He was flown to a nearby camp for immediate surgery....

Then was transferred to the National Naval Medical Center in Bethesda, Maryland, where his mother, Jeri Domson from Billings, got to see him for the first time.

"I started crying, it was overwhelming. You know, that's your baby laying there," said Domson about the extent of her son's injuries. "To hear he'd been shot at in the face, in the neck and in the shoulder, you don't know what you're going to see. "...

Stroble has been back at home since December, but his heart is still with his fellow marines.

"You know they saved my life, there's no doubt about it," Stroble says full of emotion. "They're still over there and that tears me up because they're still over fighting and I was here having Christmas dinner."...

And he urges fellow Americans to remember the harsh realities of war and those that are fighting for our freedoms.

"The guys outside the wire are risking it everyday. Just don't forget about them," Stroble said.

The helmet of a United States Marine who was lightly injured in an explosion sits on the floor of a helicopter from Task Force Shadow "Dust Off", Charlie Company 1-214 Aviation Regiment, following a mission near Marjah in the volatile Helmand Province, Southern Afghanistan, Tuesday, Jan. 18, 2011. (AP Photo/Kevin Frayer)

18 January 2011

The Air National Guard will station at least one critical care air transport team, or CCATT, at Ramstein Air Base for the next two years. The Guard units will help ease the load on active-duty CCATT units, such as this one, which flew patients from Afghanistan to Germany in April last year. Photo: Daniel Riley/Courtesy of U.S. Air Force.

RAMSTEIN AIR BASE, Germany — Mounting evacuations (see related story here) have led the Air National Guard to start fielding critical care air transport teams, medical specialists who treat severely injured servicemembers during flight.

“The active-duty side is getting heavily stressed continually manning all these missions,” said Air Force Dr. (Lt. Col.) Raymond Fang, trauma director at Landstuhl Regional Medical Center in Germany. “So having another pool of personnel who are capable and willing to help is welcome.”

At least one, three-member critical care air transport team, or CCATT, from the Air Guard will be stationed at Ramstein Air Base for the next two years, said Brig. Gen. John D. Owen, assistant to the command surgeon for Air Mobility Command. The team’s primary mission will be to care for patients as they make the long journey across the Atlantic to Joint Base Andrews in Maryland, and then on to Walter Reed Army Medical Center. But the team could deploy worldwide, including to Iraq, Afghanistan or Africa.

“They could be airborne to anywhere in the globe in three hours,” Owen said.

The Air Guard currently has about 18 CCATTs from 17 states.

To make it easier for the guardsmen to take time off from their day jobs, the tours have been shortened to between 30 and 120 days, Owen said.

“Our civilian physicians, many of them have private practices, and they cannot leave for long periods of time,” he said. “This allows them to come over here.”...

“Planning is extremely important,” said Dr. (Col.) Bruce R. Guerdan, state air surgeon for the Florida Air National Guard, who is leading the guard’s first CCATT rotation at Ramstein. “You have a lot of capabilities, but the only capabilities you have are the ones you bring with you. You can’t call for extra supplies or extra blood or the specialist while you are flying over the Atlantic or flying downrange.”...

Not only do the guardsmen provide much needed manpower, Fang said, but they also bring expertise. Guerdan has worked in emergency medicine for more than two decades.

“There is not a wealth of critical care experience on the active duty side all the time,” Fang said. “The guard folks, that’s what they do in their everyday job in civilian hospitals all over the U.S.”

This is not Guerdan’s first time leading a CCATT. He had been a part of the Air Guard’s previous critical care air transport program, which was shut down about five years ago. He is eager to be doing it again.

“You do all this intensive training,” he said, “and you want to use it. Also is there a more important mission? I don’t think so.”

The biggest technological change to the aeromedical mission has been the transition from the C-141 Starlifter to the KC-135.

“Those planes are in the boneyard now,” said Dr. (Col.) Bruce Guerdan, a Florida Air Guard state surgeon who is a member of the first Air Guard CCATT currently deployed here [at Ramstein]. “The tanker was not designed to carry patients. We have changed lighting, oxygen systems, stanchions for the stretchers. That plane has been turned into something that it never was.”

The 50-year-old airframe is not the same plane it was about five years ago. “There has been a huge investment of times and energy to make those planes adequate air frames to carry patients,” Guerdan said.

Owen said the tanker was chosen, because it is fast, can carry a lot of fuel and can fly long distances.

“The KC-135 can fly back to the U.S. from Afghanistan unrefueled with the proper clearances,” he said. “The aircraft is very stable. It does have some limitations, but with the modernization it provides a very capable platform.”

He added that the C-17 is the premier aircraft for aeromedical evacuation, but the Air Force doesn’t have as many available for the mission.

“Thanks to everybody,” said Marine Sgt. Blank via Skype to about 1000 supporters gathered at a High School gym back home, “I was lucky to be born where I was and live among such great people.” Sgt. Blank of Augusta, KS talked about the serious injuries he sustained while on recon duty with his unit Oct. 26, 2010 in Afghanistan and his ongoing recovery.

At the request of Skype interviewer Todd Hollis, Kansas Army National Guardsman and Augusta High teacher, Jon told his story about the day of his injuries.

The unit was keeping an eye on the Taliban in a southwest Afghanistan desert area.

This unit had set up in an abandoned compound. They spent a night there, but when the sun rose the next morning, the U.S. forces heard radio traffic about “Americans were moving in the area” and the Taliban was moving on those soldiers.

Being a well-trained Marine, Jon said he and fellow soldiers felt they were “up to the challenge.”

He walked into an area thought to be safe because mine sweeping had not turned up any IED’s there.

“Suddenly, everything went white,” said Jon. “I felt a dirty, dusty rain and tried crawling. I saw blood and knew one of my legs was blown off.”

He spoke about the doctor asking him on a 1-10 scale, how bad did he hurt. “It hurts.” Jon replied, asking for morphine. He said the field medics “shot him up.”

Blank reported his son asked hospital staff about the record recovery time from injuries such as his and was told “four and a half months." His father feels it might be more like a year, but said Jon told the staff. “I expect to at least tie that recovery record.

Kansas Army National Guardsman and Augusta High School teacher Sgt. Todd Hollis, along with Jon's twin brother Linden Blank (who is also a former Marine) and friend Rachel, attended to the Skype equipment in the gym. Photo: Michael McDermott, Augusta Gazette.

13 January 2011

A wounded Afghan soldier was carried to an American medevac helicopter in Kandahar Province, Afghanistan, on Dec. 7. Photo: Tyler Hicks/The New York Times.

Nearly 5,500 US troops suffered combat injuries in Afghanistan in 2010 - more than twice the number wounded in 2009. But fatalities among wounded declined, due to advances in battlefield medical evacuation and treatment that CJ Chivers describes as a "contest [which] pits a multilayered and expensive effort to keep troops alive against the sharply increased rate at which they suffer grievous injuries, some beyond what any medical system can heal."

KHAKREZ DISTRICT, Afghanistan — Intensified fighting and a larger troop presence in Afghanistan in 2010 led to the highest American combat casualties yet in the war, as the number of troops wounded by bullets, shrapnel and bombs approached that of the bloodiest periods of the war in Iraq.

But the available data points to advances in the treatment of the fallen, as the rate at which wounded soldiers who died reached a wartime low.

More than 430 American service members died from hostile action in Afghanistan last year through Dec. 21, according to official data released by the Pentagon last week at the request of The New York Times.

This was a small fraction of those struck. Nearly 5,500 American troops were wounded in action — more than double the total of 2,415 in 2009, and almost six times the number wounded in 2008.

In all, fewer than 7.9 percent of the Americans wounded in 2010 died, down from more than 11 percent the previous year and 14.3 percent in 2008.

The fatality rate declined even though many more troops patrolled on foot, exposing the force to greater dangers than in years past. Several doctors said the improvements came not from a single breakthrough but through a series of lessons learned over nearly a decade of fighting two wars, such as placing medevac helicopters closer to the fighting and the more extensive use of tourniquets.

Although fatality rates for wounded Afghan troops are not similarly available, doctors involved in their care said hospital records showed that they trail those of Western troops by a few percentage points, but have also fallen.

Several soldiers and those who care for them framed the improved survival rates as the grimmest sort of success. Many more troops — some missing multiple limbs or their genitals, or suffering brain damage — are being rescued from near death. But their wounds will be exceptionally difficult to overcome later as they try to resume work, and social and family lives.

Along with interviews with medics and military doctors, and a month spent by two journalists from The Times observing the collection and immediate treatment of troops suffering from a wide range of trauma, the data shows the results, in broad terms, of an evolving contest for wounded soldiers’ fates.

The contest pits a multilayered and expensive effort to keep troops alive against the sharply increased rate at which they suffer grievous injuries, some beyond what any medical system can heal.

A clear decline was evident: In 2005, 19.8 percent of wounded American soldiers died from their injuries. For the past five years in Afghanistan and Iraq, the fatality rates for wounded Americans have otherwise fluctuated between 9.4 and 14.3 percent.

(The data draws from a sample running into the tens of thousands; in 2006 in Iraq, for example, nearly 7,200 American troops were wounded by hostile action, more than 700 of them fatally.)

The statistics further served to reinforce consistent trends in the battlefield’s array of lethal hazards, and offered glimpses of wars within the war.

More soldiers in Afghanistan in 2010 were wounded by explosive devices (at least 3,615, compared to 828 troops reported to suffer gunshot wounds). But the higher fatality rates from gunshot wounds (12.9 percent versus 7.3 percent for wounds caused by bombs) made rifles and machine guns the most statistically deadly weapons.

Rocket-propelled grenades, for all their ferocious reputation, proved less of a threat. They wounded 373 American soldiers, of whom 13 — 3.5 percent — died.

The following poem was written during the 19th and final year of Gunnar's life. He was laid to rest on his 20th birthday. His life was short, but full of love and meaning for all who knew him - and for many more who didn't.

We will love and remember him always.

We are soldiers.
We are soldiers in the United States Army.
We are trained to be all we can be.

We fight for the freedom of many citizens of the United States. We are all ready to meet our fates.

We all volunteer to defend the red, white and blue.
Not only the flag, but for the citizens of our great country too.

Since our country's birth for all these years,
we have been trained to be the best on Earth.

Many times we have went to war.
We will be involved in many more.

Generation by generation soldiers continue to enlist.
Some of us will go to war and definitely be missed.

Some soldiers will return and some won't.
Those who do not, we won't forget and we hope you don't.

Many of us are going to Iraq.
Some of us won't be coming back.

We have loved ones we are leaving behind.
They will always be in our prayers, hearts and mind.

If we don't make it home safely at the end of the war,
just remember we died defending the beliefs of those of many more.

Rep. Gabrielle Giffords, gunshot wound through her brain, was fortunate enough to be wheeled into the emergency room of a uniquely qualified surgeon: Dr. Peter Rhee, a 24-year military surgeon who has treated "hundreds and hundreds" of battlefield injuries during stints in Iraq and Afghanistan.

Rhee, 49, chief of trauma at University Medical Center in Tucson, said his work in the Navy tending to injured soldiers and Marines and teaching the next generation of battlefield medical personnel unquestionably played a role in his ability to treat Giffords and direct care for the 10 other victims who began arriving in his unit Saturday morning.

"There's no doubt," he said. "I was in the Navy 24 years, and I trained to do nothing but battlefield casualty care. When I did go to Afghanistan and Iraq, I wasn't in a hospital. I was in very forward surgical units, so I was very accustomed to working with very little gear and people and personnel, very little resources, with wounds that are very different than civilian injuries," Rhee said Sunday. "Did it prepare me? I would say of course it did. And that makes it so that when we have a mass casualty of 11 people here, it's really not as bad as it can get."

Rhee said he handled "hundreds and hundreds" of battlefield injuries in two war deployments beginning in 2001. He was one of the first battlefield surgeons to be deployed to Camp Rhino, the first U.S. land base in Afghanistan, located in the remote desert about 100 miles southwest of Kandahar. In 2005, he served in Iraq....

Navy medicine spokesman Capt. Cappy Surette said Rhee worked closely with medical teams developing the trauma training programs "that are the benchmark of the unparalleled trauma care being provided to our people on the battlefield today."

07 January 2011

Maj. Gen. Francis Wiercinski, the acting senior commander for 101st Airborne Division, presents an Air Medal to Spc. Leandro Garcia, a fueler with the 563rd Aviation Support Battalion, 159th Combat Aviation Brigade, during a ceremony at Fort Campbell, Ky., Jan. 4. Garcia received the award and a Purple Heart for his actions when the CH-47 Chinook he was in was shot down by enemy fire in the Korengal Valley during a 2009 Afghanistan deployment. Photo credit Spc. Shanika Futrell.

Maj. Gen. Francis Wiercinski, the acting senior commander for the 101st Airborne Division, presented the awards to Spc. Leandro Garcia for exceptional meritorious service while serving as a door gunner aboard a CH-47 Chinook that was shot down by enemy fire during the 159th CAB's deployment to Afghanistan last year.

"It was an honor to have someone so high in the chain of command to take the time and present me with this award today," said Garcia.

Garcia is a truck driver who volunteered to serve as a Chinook door gunner with 7th Squadron, 17th Cavalry Regiment, during the deployment and participated in extensive training to prepare him for this role.

"It was the training our unit instilled in the crew that brought us back," said Garcia. "Training was essential to this mission, and I am thankful that we were prepared."

The Jan. 17, 2009, mission that led to Garcia's awards was supposed to be a routine resupply mission to Outpost Restrepo. But Outpost Restrepo was located in the heart of the Korengal Valley, which was at one time dubbed "the most deadly place on Earth."

During the mission Garcia's aircraft was hit by a Rocket-Propelled Grenade that caused a fire to break out in the cabin.

While the flight engineer attempted to put the fire out, Garcia remained focused on helping the aircrew survive. He continued to scan for enemy threats. He also helped identify an adequate emergency landing zone, as the Chinook would not be able to reach a secure area.

Minus a rear port side fuel cell, and ablaze, the aircraft made a hard landing approximately 300 meters from Observation Point Vegas and proceeded to roll onto its side.

Garcia was immediately knocked unconscious and pinned under debris inside the aircraft.

"I am thankful to be here today, and that I only suffered minor injuries," he said.

When Garcia regained consciousness and freed himself of the debris, he exited the aircraft, but realized he'd suffered injuries to his right side.

To the Rescue: Members of Charlie Company of the 1-214th, known as "Dustoff", come to the aid of a Marine severely wounded by an IED in Marjah, Afghanistan. Photo: James Nachtwey for TIME.

Photo essay of MEDEVAC crews in action by renowned photographer Jim Nachtwey. We can never repay the sacrifices made for all of us, and are so grateful for and proud of our medics who risk their lives so that others may live. Please be advised that images of MEDEVAC missions can - by their very nature - be distressing.

02 January 2011

US Army flight Medic SGT Patrick Schultz talks to a wounded US soldier in the rear of a medevac helicopter while enroute to Kandahar Airfield after he was injured by an improvised explosive device in Zhari District, Kandahar, Afghanistan. Photo: Louie Palu/ZUMA Press.